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Lipid was found to accumulate in the subretinal space during rhegnatogenous retinal detachment. The concentration of lipid in the subretinal fluid varied between 0.1 to 2.4 mg. per milliliter. Based upon a comparison of lipid profiles and lipoprotein profiles, the amount of lipid observed in the subretinal fluids was not directly related to the permeability of the ocular vessels. Thin-layer chromatography analyses of lipid in subretinal fluids showed differences between the lipid composition of the subretinal fluid and blood. The major characteristic of lipid composition of subretinal fluid is the low concentration of lecithin, which is the major lipid compound in the serum. The present data indicate that the lipids of ocular tissues are released into the subretinal space during rhegmatogenous retinal detachment, and are adsorbed on albumin.

A 16-year-old boy with Fabry's disease had sudden onset of diplopia unassociated with any other neurologic symptoms. A right internuclear ophthalmoplegia characterized by optokinetic phenomena and ocular dysmetria was demonstrated. The diplopia resolved spontaneously in six weeks. This is the first reported case of internuclear ophthalmoplegia occurring with Fabry's disease and represents one of the youngest patients to have unilateral internuclear ophthalmoplegia presumably caused by vascular occlusive disease.

By electron microscopy, the cryogenic chorioretinal adhesions in eight-day-old lesions from human eyes lacked anatomic adhesion between retina and choroid. In eight-month-old lesions, the neurosensory retina adhered to the retinal pigemtn epithelial layer by both desmosomal attachments and villous interdigitation.

Indomethacin is used to induce pharmacologic closure of symptomatic patent ductus arteriosus in premature infants. 1,2 This study was performed to examine the influence of this medication on retinopathy of prematurity. Indomethacin was used for primary medical therapy of symptomatic patent ductus arteriosus in 45 newborn infants at Vanderbilt Hospital who had birthweights of less than 1,000 g. Retinal examinations were done at monthly intervals until complete normal retinal vascularization occurred or until there was no evidence of remodelling of the cicatricial retinopathy of prematurity at two separate examinations. No infant underwent cryotherapy, scleral buckling, or vitrectomy. Although asymmetric retinal abnormalities were noted, the use of a previously described grading system 3 permitted both eyes of each infant to be at the same grade level. The incidence of cicatricial retinopathy of prematurity was no different in the study population than in a birthweight-matched population seen in the same nursery during the same period.

Thirteen patients who underwent radial keratotomy developed complications leading to visual impairment. Three eyes were legally blind. Two groups of complications were seen: those common to surgical procedures involving the eye--optic atrophy, infections, cataract and retinal detachment, and those unique to radial keratotomy--complete failure of the procedure, marked undercorrection, marked overcorrection, and induced astigmatism. Symptoms due to anisometropia were prominent in the latter group who considered themselves visually disabled by the surgery. Radial keratotomy, like all surgical procedures, is liable to complications that may lead to visual impairment, blindness, or loss of an eye.

Twenty-four eyes with macular holes have been followed for periods ranging from one to four years. Each hole was demonstrated, clinically, to be full thickness and associated with a small, localized, retinal detachment and a posterior vitreous separation. With one exception, all eyes were within three diopters of emmetropia, and only one eye developed progression of the retinal detachment. A high incidence of systemic estrogen therapy was noted in these patients.

Vitamin A deficiency associated with retinopathy and night blindness was observed in a patient 4 yr after jejunoileal bypass. Upon further investigation, a multiple vitamin deficiency state was established. Daily supplementation with 30 000 units of vitamin A resulted in normal levels of vitamin A and retinol-binding protein. The patient's night blindness improved, but his retinopathy remained unchanged as demonstrated by fluorescein angiography. We conclude that patients who have undergone jejunoileal bypass should be supplemented with vitamin A since the vitamin A deficiency is preventable and the retinopathy associated with the deficiency may not be totally reversible.

Two carboxyl esterases of subretinal fluid, previously observed by electrophoretic analyses have been isolated by a DEAE-cellulose chromatography procedure for biochemical studies. Both of them have similar molecular weight and substrate specificity to acetyl esters. They are inhibited by fluoride, yet are insensitive to eserine. Their biochemical properties are identical to two esterases of a leukocyte extract obtained from a patient with monocytic leukemia, and different from those of serum enzymes. Although peak I has biochemical properties and electrophoretic mobility similar to a retinal esterase, they differ in their affinity to DEAE-cellulose. The data suggest the potential use of esterases as marker enzymes in future studies for evaluating macrophage activity in the subretinal space.

Excerpt In the past 10 years some 500 Americans have been discharged home on self-administered parenteral nutrition (Registry of Patients on Home Parenteral Nutrition, New York Academy of Science, ...

Under normal conditions the retinal pigment epithelium does not permit passage of peroxidase tracers. Photocoagulation disrupts this barrier. Rhesus monkeys which received transconjunctival cryotheropy showed a similar disruption, with leakage of horseradish peroxidase into the retina. This leakage persisted for the 6-month duration of the experiment. One month after treatment, a firm chorioretinal adhesion was present, characterized by gliosis, adherent junctions, and cellular interdigitation. The anatomic features of the cryogenic chorioretinal adhesion were similar to those previously described in human eyes.

Sclerocornea is a primary anomaly in which scleralization of a peripheral part of the cornea, or the entire corneal tissue, occurs. In the peripheral type of sclerocornea, the affected area is vascularized with regular arcades of superficial scleral vessels. In total sclerocornea, the entire cornea is opaque and vascularized. To our knowledge, 97 cases of all types of sclerocornea have been reported in the world literature, either as a primary anomaly or in association with cornea plana. Peripheral sclerocornea in association with cornea plana was found in nine members of one family, in four of five generations studied. To our knowledge, this is the largest pedigree of hereditary peripheral sclerocornea identified. Our pedigree suggests the autosomal-dominant transmission of this entity but doesn't rule out phenocopies or other modes of inheritance in other cases of sclerocornea. Chromosomal analyses of representative family members revealed normal karyotypes.

Chorioretinitis developed in the right eye of a patient with contact lens-associated Acanthamoeba keratitis in the left eye during an acute exacerbation of the keratitis. This chorioretinitis may have resulted from hematogenous dissemination from his corneal infection.

• Two patients with histories of migraine had ischemic optic neuropathy develop during an episode of migraine. Clinical and radiologic studies excluded other causes of visual loss. Fluorescein angiography confirmed an ischemic process involving the optic disc. In both cases, visual loss was permanent. No further visual disturbance has occurred in either patient during a two-year period of follow-up while taking oral doses of propranolol hydrochloride.

In the past 20 years, the survival rates for premature infants have improved. To reassess the incidence of cicatricial retinopathy of prematurity, 197 consecutive premature infants were examined. Each child was seen at intervals until age 6 months. Changes that could influence visual acuity were found in 22% of those with birth weight less than 1,000 g; 10% of those between 1,001 and 1,250 g; and 0% of those greater than 1,250 g. These findings were compared to a similar study performed at our university a decade earlier. A significant reduction in the incidence of premature retinopathy was demonstrated. However, because greater numbers of profoundly premature infants are surviving, the number of children with retinopathy of prematurity appears to be increasing.

A macular hole was responsible for retinal detachment in 0.5% of patients with rhegmatogenous retinal detachment operated on at the Jules Stein Eye Institute. Surgical treatment with cryotherapy and a Y-shaped sling made of cylindrical silicone sponge resulted in anatomically successful repairs in all cases.

Presumed ocular histoplasmosis syndrome is a multifocal choroiditis; it is not an uncommon cause of visual loss in patients who have positive cutaneous responses to histoplasmin tests. However, Histoplasma capsulatum infection is, most often, a pulmonary disease, or a systemically disseminated disorder, without visual symptoms. For this reason, a correspondence between the nonocular and ocular aspects of this disorder has been difficult to ascertain. In a series of eight patients with histoplasmosis, we found asymptomatic ocular lesions in six. We believe that the presence of asymptomatic lesions may have prevented earlier investigators from recognizing this correlation. ( JAMA 1985;253:2534-2537)

Systemic anticoagulation caused severe intraocular hemorrhage and blindness that necessitated enucleation. The patient's eye was predisposed to hemorrhage because of disciform degeneration of the macula. This ocular disease is related to a regional vasculopathy that causes macular exudation and hemorrhage with slowly progressive organization and loss of central vision.